Optimal management of ADHD in older adults

Abstract

BackgroundThe manifestation of attention-deficit/hyperactivity disorder (ADHD) among older adults has become an interesting topic of interest due to an increasing number of adults aged 50 years and older (≥50 years) seeking assessment for ADHD. Unfortunately, there is a lack of research on ADHD in older adults, and until recently only a few case reports existed.MethodA systematic search was conducted in the databases Medline/PubMed and PsycINFO in order to identify studies regarding ADHD in adults ≥50 years.ResultsADHD persists into older ages in many patients, but the prevalence of patients fulfilling the criteria for the diagnosis at age ≥50 years is still unknown. It is reason to believe that the prevalence is falling gradually with age, and that the ADHD symptom level is significantly lower in the age group 70–80 years than the group 50–60 years. There is a lack of controlled studies of ADHD medication in adults ≥50 years, but this review suggests that many patients aged ≥50 years experience beneficial effects of pharmacological treatment. The problem with side effects and somatic complications may rise to a level that makes pharmacotherapy for ADHD difficult after the age of 65 years. Physical assessment prior to initiation of ADHD medication in adults ≥50 years should include a thorough clinical examination, and medication should be titrated with low doses initially and with a slow increase. In motivated patients, different psychological therapies alone or in addition to pharmacotherapy should be considered.ConclusionIt is essential when treating older adult patients with ADHD to provide good support based on knowledge and understanding of how ADHD symptoms have affected health, quality of life, and function through the life span. Individualized therapy for each elderly patient should be recommended to balance risk–benefit ratio when pharmacotherapy is considered to be a possible treatment.

ADHD in old age: a review of the literature and proposal for assessment and treatment

“…In older adults with ADHD, no randomized controlled trials (RCTs) have been performed so far to examine the effect and safety of stimulants; more information is available on treatment of older patients with methylphenidate in depression and dementia (see paragraphs below) [83]. However, case studies show beneficial effects of stimulants in this age group.…”

Being Different but Striving to Seem Normal: The Lived Experiences of People Aged 50+ with ADHD

“…Adult ADHD can be found in the research literature since 1976 (Wood, Reimherr, Wender, & Johnson, 1976). Subsequent research shows that ADHD persists into adulthood (Fayyad et al, 2017;Semeijn et al, 2016), and old age (Torgersen, Gjervan, Lensing, & Rasmussen, 2016).…”

“…A growing number of people age 50 years and older are diagnosed and treated for ADHD worldwide (Torgersen et al, 2016). In Longitudinal Aging Study Amsterdam (LASA), Michielsen et al (2012) by a random sample of men and women (N ¼ 231) aged 55-85 years, concluded that 2.8% of older adults had full-blown syndromatic ADHD and 4.2% symptomatic ADHD.…”

Attention disorder with hyperactivity: possible persistence in the adult and working difficulty

“…Pharmacological treatment in older adults should generally follow similar guidelines as with younger patients except that drug dosing and speed of titration should be slower and start lower. Side effect profile is a greater consideration than with younger patients (5). Research on ADHD is proceeding exponentially.…”

“…ADHD afflicts 7-8% of school-age children and 4-5% of the adult population (2,3). In fact, while some "outgrow" the disorder, symptoms persist beyond adolescence in as many as 65% of individuals (4,5).…”